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Biomedical subjects

C Militello

Publications and source records attributed to C Militello.

At least 19 recordsLinked to original sources
PubMed2005

Palliative surgery for gastric cancer in elderly patients.

Poor survival rate of elderly patients affected by locally advanced or metastatic gastric cancer is related to primary tumour complications. Bleeding is the most important adverse event, other major complications are gastric outlet obstruction and nutritional deprivation. Rarely the patients will perforate the stomach cancer and there is a sudden end to their life; contamination of the ascites result in a rapid death. Thus, an aggressive approach toward palliation of this condition is resection: in this manner the expected survival is approximately one year. Derivation techniques or endoscopic treatments are applied in those patients whose operative risk is inacceptable; in these cases poor median survival is expected. The aim of this report in to refer about the experience in palliative surgery for gastric cancer in the Department of Geriatric Surgery of the University of Padua.

Aged↗
PubMed2001

Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU".

BACKGROUND: Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly. AIMS: To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres. PATIENTS: Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms. METHODS: Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection. RESULTS: A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction. CONCLUSIONS: Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.

Barrett Esophagus↗
PubMed1999

Electromagnetic interference of digital and analog cellular telephones with implantable cardioverter defibrillators: in vitro and in vivo studies.

The present study examines the potential electromagnetic interference effects induced by cellular telephones on ICDs. We developed ad hoc protocols to conduct both in vitro and in vivo trials on most of the implantable cardioverter defibrillators available on the international market. Trials were conducted with three cellular telephones: two GSM (Global System for Mobile Communication) and one TACS (Total Access Communication System). A human trunk simulator was used to carry out in vitro observations on six ICDs from five manufacturers. In vivo tests were conducted on 13 informed patients with eight different ICD models. During the trials in air, GSM telephones induced interference effects on 4 out of the 6 cardioverter defibrillators tested. Specifically, pulse inhibition, reprogramming, false ventricular fibrillation, and ventricular tachycardia detections occurred, which would have entailed inappropriate therapy delivery had this been activated. Effects were circumscribed to the area closely surrounding the connectors. When the ICD was immersed in saline solution, no effects were observed. Three cases of just ventricular triggering with the interfering signal were observed in vivo.

Aged↗
PubMed1997

Comparison of dobutamine ECG stress test with predischarge exercise test after acute myocardial infarction.

Exercise testing after acute myocardial infarction is commonly used, but in recent years alternative methods have been proposed. Standard exercise testing was compared with dobutamine electrocardiographic (ECG) stress testing in 100 patients after an acute initial myocardial infarction. Dobutamine ECG stress testing was performed in a standard manner at 5 +/- 1 days after the infarction and exercise testing was performed a mean of 10 +/- 2 days following the event. Agreement between both tests was observed in 91 cases (91%), P < .001, Fisher test kappa value, 0.79). The dobutamine test predicted the result of the exercise test with a sensitivity of 100% (95% confidence interval, 87-100) and a specificity of 88% (95% confidence interval 77-93) for a positive predictive value of 75% (95% confidence interval, 62-97) and a negative predictive value of 100% (95% confidence interval, 91-100). Dobutamine ECG stress testing is concluded to be an objective and reliable procedure, which accurately predicts the results of standard exercise testing. It is inexpensive, easy to perform, and although not yet confirmed, could be particularly useful in patients who cannot perform exercise.

Aged↗
PubMed1997

Clinical evaluation and safety of loxiglumide (CCK-A receptor antagonist) in nonresectable pancreatic cancer patients. Italian Pancreatic Cancer Study Group.

The effects and safety of loxiglumide, a cholecystokinin-A (CCK-A) receptor antagonist, on advanced pancreatic cancer were investigated in humans. A perspective, controlled (2.4 g/day vs. placebo), randomized, double-blind, parallel-group study was performed in 64 patients affected by nonresectable histologically diagnosed pancreatic cancer. The patients were stratified according to sex and stage (A, T3/N0-N1/M0; B, T1-T2-T3/N0-N1/M1; C, relapse after surgical exeresis). Tumor size (by computed tomography scan) and mortality rate were evaluated as efficacy criteria. Clinical symptoms and physical signs, laboratory tests, and adverse reactions were checked every 6 weeks as efficacy/tolerability criteria. Forty-two male and twenty-two female patients were considered. A homogeneous distribution of the patients was demonstrated in the two treatment groups. Group C was not statistically evaluated for survival and tumor evolution because of its small number. Three patients dropped out for causes not related to the therapy. No toxic reactions to the drug were reported. Tumor size monitoring within groups A and B demonstrated a similar increase in both the loxiglumide and the placebo group. Survival in group A was higher than in group B (p = 0.0003). In group B, survival was lower in females (F) than in males (M) (F = 61.00 +/- 6.47 days, M = 140.44 +/- 22.15 days; p = 0.012), while survival by sex was similar in group A and in global analysis. Survival by treatment was similar for groups A and B. Survival by surgery was higher (p = 0.049) for surgical palliation than for nonoperated patients. The tumor grade affected survival but it did not vary by therapy. In conclusion, sure efficacy of loxiglumide in advanced pancreatic cancer was not demonstrated by our results. In consideration of its documented tumor growth inhibiting action, we suggest that loxiglumide be tested for recurrence prevention after resective surgery.

Double-Blind Method↗
PubMed1997

[Physiopathology of intestinal anastomoses and dehiscences].

A lot of mechanisms of healing of intestinal anastomoses has been explained. A leading role in the intestinal wall is made by the submucosal tunica, where collagen synthesis and degradation process take place, but local and systemic factors are present by a definite causal action. Technique of suture, materials and surgeon's experience are of fundamental importance for the success of operation, even if in some cases it is important to take in consideration the clinical situation: emergency or not, the patient's state and age, concomitant diseases, pharmacological or radiotherapeutic treatments. Nowadays surgical research tends towards biochemical and molecular field to identify the factors, that speed up the healing process to use them in suturing materials getting a quick healing as soon as possible.

Adult↗
PubMed1997

[Breast cancer in elderly women].

Breast cancer represents an important epidemiological and clinical problem, and the elderly age represents a large proportion of women with breast cancer. In patients older than 65-year, the frequency of breast cancer is 50% and more. Early diagnosis and adequate therapy may play an important role also in the elderly. We performed a retrospective analysis of 146 women older than 65-year to determine the effect of age in management of the disease.

Age Factors↗
PubMed1997

[Complications of peptic ulcer disease in the elderly].

Peptic disease is even more described in the elderly patients. Is it different from the young people peptic disease? Is it a specific syndrome? These questions are debated by the authors from their experience about in the old age surgery. In 1997, out of 569 oesophago-gastro-duodenoscopies positive for peptic disease, about 2/5 of the patients were older than 65-year with a high percentage of hypersecretive patients. Also the incidence of complications is similar in the aged and young patients, but their course is much more serious in the elderly. NSAID therapy was not always demonstrated as a determining factor of complications in the elderly. The ulcer perforation is the most serious complication; in the over-70 year aged persons a very severe course is often demonstrated. In conclusion in the elderly a specific diagnostic and therapeutic care is recommended to avoid the high incidence of deadly complications.

Age Factors↗
PubMed1997

[Stomach cancer in the elderly].

Gastric cancer often affect very old patients even if it is not a typical disease of the elderly. The Authors report their experience on 108 patients (mean age of 77.8 years) affected by gastric cancer; early diagnosis and surgical technique are discussed.

Age Factors↗
PubMed1997

[Surgery of inguinal and femoral hernia in the elderly].

Old people are continuously increasing in frequency but age is not a significant factor to value the operative risk in hernia surgery. From June 1985 to December 1996, 189 patients, aged > 80-year, were submitted to hernia surgery. No complications were noted when elective surgery was performed. Emergent procedure was undertaken in 7% of the patients major perioperative complications and one death were registered in this group of patients. Mean hospital stay has decreased in the period of the study: was 2.2 days in the last two years. Local anesthesia permitted a day surgery procedure in 60% of cases.

Aged↗
PubMed1996

Electromagnetic interference of analog cellular telephones with pacemakers.

The aim of this study was to verify whether there is a public health risk from the interference of analog cellular telephones with pacemakers. We used a human trunk simulator to reproduce an actual implant, and two cellular telephones working with the TACS (Total Access Communication System) standard. Results showed that the electromagnetic field radiated from the analog cellular telephones interfered with a large number of the pacemakers tested (10/25). When the telephone antenna was in close proximity to the pacemaker head, pacemaker desensitizing and sensitizing and pulse inhibition was detected at the moment of an incoming call and throughout ringing. In the worst case of pulse inhibition, the pacemaker skipped three nonconsecutive beats and then resumed its normal pacing, while the desensitizing and sensitizing phenomena persisted as long as the interfering signal was on. Pulse inhibition was also observed when the connection did not succeed. Maximum sensing threshold variation was about 186% (increase) and 62% (decrease) for desensitizing and sensitizing phenomena, respectively. It was also demonstrated that the signal emitted by analog cellular telephones during the crossing of contiguous cells could induce pacemaker pulse inhibition, but under our experimental conditions this event did not seem to pose a risk for the pacemaker patient.

Electromagnetic Fields↗
PubMed1995

Do European GSM mobile cellular phones pose a potential risk to pacemaker patients?

A series of in vivo trials were carried out in order to verify whether the electromagnetic field radiated by GSM (Groupe Systemes Mobiles) mobile cellular phones might affect implanted pacemakers. Two European GSM phones of 2-watt power were tested and trials conducted on 101 pacemaker implanted outpatients attending day hospital for routine check-up, who volunteered for trials. Forty-three pacemaker models from 11 manufacturers were tested in all. When the sensing threshold of the pacemakers was set at a minimum and the antenna of the phone was in direct contact with the patient's chest, interference was detected for 26 implanted pacemakers. Specifically, pulse inhibition in 10 of 101 cases, ventricular triggering in 9 of 46 DDD-VDD pacemakers, and asynchronous pacing in 4 of 52 devices. Pulse inhibition was also observed combined with asynchronous pacing in 1 of 52 cases and with ventricular triggering in 2 of 46 cases. Minimum effect duration was ca. 3 seconds but in 6 cases effects continued as long as the interfering GSM signal was on. No permanent malfunctioning or changes in the programmed parameters were detected. Whenever interference was detected, trials were repeated to determine the maximum sensing threshold at which interference persisted (with the antenna in contact with the skin over the pacemaker). Then maximum distance between antenna and pacemaker at which interference occurred was determined at pacemaker maximum and minimum sensing threshold. Under our experimental conditions electromagnetic interference effects were detected at a maximum distance of 10 cm with the pacemaker programmed at its minimum sensing threshold.(ABSTRACT TRUNCATED AT 250 WORDS)

Electricity↗
PubMed1994

Effect of cholecystokinin analogue caerulein and cholecystokinin antagonist lorglumide on pancreatic carcinogenesis in the rat.

The effects of the cholecystokinin (CCK)-analogue, caerulein, and CCK-receptor antagonist lorglumide (CR-1409) on pancreatic carcinogenesis induced by 7,12-dimethylbenz(a)anthracene (DMBA) were studied. One hundred thirty rats were divided into the following 10 treatment groups: group 1, DMBA (2-3 mg); group 2, DMBA + caerulein (5 micrograms/kg); group 3, DMBA + caerulein + CR-1409 (12 mg/kg); group 4, caerulein + DMBA; group 5, caerulein + CR-1409 + DMBA; group 6, DMBA + CR-1409; group 7, CR-1409 + DMBA; group 8, caerulein; group 9, CR-1409; and group 10, sham operation + saline. DMBA was surgically implanted into the pancreas. Caerulein and/or CR-1409 was administered twice daily for 15 days after (in groups 2, 3, and 6) or before (in groups 4, 5, and 7) DMBA implantation. Six months after carcinogen administration, all rats were sacrificed and autopsied. The incidence of pancreatic cancer appeared significantly (P < 0.001) increased when caerulein was administered following DMBA implantation. CR-1409 significantly inhibited (P < 0.02) caerulein effects and reduced tumor growth when injected after carcinogen exposure.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1993

Cystic neoplasms of the pancreas: problems in differential diagnosis.

From 1970 to 1990 we observed 18 patients with histologically proven pancreatic cystic tumors. The average duration of symptoms prior to diagnosis was 14.1 months. A presumptive diagnosis was made preoperatively in nine patients. CT-guided fine needle cytology performed in three cases correctly showed a benign lesion in one patient and malignancy in two patients. Amylase and tumoral marker levels (CEA, CA19-9) were low in cystic fluid of two patients with cystadenomas who underwent preoperative percutaneous aspiration. Intraoperative biopsy of the cystic wall failed to detect epithelial lining in two cases; one patient had internal drainage for cystadenocarcinoma mistaken for pancreatic pseudocyst. Sixteen patients underwent surgery, two of whom died. Of the seven patients with a malignant condition, resection for cure was performed on three. The preoperative diagnosis of these very rare tumors remains difficult. Fine-needle cytology and cystic fluid examination may be a promising technique, but resection of all suspected lesions, whenever possible, is the procedure of choice for diagnosis and treatment.

Adolescent↗
PubMed1992

Effect of castration and testosterone replacement on pancreatic carcinogenesis in Syrian hamsters.

Hormonal manipulation has been proposed as a possible new approach to the treatment of pancreatic cancer. We studied the effect of orchiectomy and testosterone replacement on early stage pancreatic carcinogenesis induced by diisopropanolnitrosamine (DIPIN) in Syrian golden hamsters. Eighty-five hamsters (mean body weight, 100 g) were divided into the following treatment groups: 1) DIPN (n = 20); 2) DIPN plus orchiectomy (n = 17); 3) DIPN plus orchiectomy plus testosterone (n = 18); 4) orchiectomy (n = 10); 5) sham operation (n = 10); 6) DIPN plus testosterone (n = 10). DIPN (125 mg/kg/body wt.) was administered s.c. every week and testosterone propionate (10 micrograms/g) was administered s.c. every 3 weeks. Bilateral orchiectomy was performed 1 week after the first injection of DIPN. All animals were killed 15 weeks after starting the treatment. The whole pancreas was removed, weighted and histologically examined. There was no difference in the incidence of preneoplastic lesions among groups 1, 2, 3 and 6 (respectively 87%, 83%, 77% and 80%); 3 animals in each group developed invasive carcinoma. In control groups (4 and 5), no precancerous lesions were recorded. In this experimental model, orchiectomy and testosterone replacement had no effect on nitrosamine-induced pancreatic carcinogenesis.

Animals↗
PubMed1992

Evaluation of surgical risk in palliation and resection of pancreatic cancer. Perspective study and tables to calculate the risk.

High morbidity and mortality rates are reported for bypass and resective surgery of pancreatic cancer. In a retrospective study we correctly predicted the postoperative course in 88% of the patients who underwent bypass surgery and 83% of those who had a resection for pancreatic cancer. Before starting with clinical application of this scoring system, we undertook a prospective study to confirm its predictive value. Sixty-seven consecutive patients with pancreatic cancer were included: 42 patients underwent bypass surgery and 25 pancreatic resections. The operative mortality was 14% for palliative surgery and 0% for resective surgery. Surgical team and nurses were totally unaware of the predicted risk. The preoperative forecast proved to be correct in 81% of bypass surgery and in 88% of resective surgery, although surgical mortality had decreased from 21 to 14% for bypass surgery and from 17 to 0% for resective surgery. Tables are included to calculate the surgical risk for each of 162 combinations of the risk factors considered in the predictive model (81 for bypass surgery and 81 for resective surgery). Calculation of surgical risk is important when evaluating different treatments for pancreatic cancer are available.

Adult↗
PubMed1992

Primary carcinoid tumor of the cystic and common bile ducts.

We report a case of primary carcinoid tumor arising at the confluence of the cystic and common bile ducts. The patient was a 64-year-old woman who developed a sudden onset of biliary colic and jaundice. Computerized tomography and nuclear magnetic resonance showed a mass lesion close to the head of the pancreas. At laparotomy a nodular lesion was found at the confluence of the cystic and common bile ducts. Microscopic observation revealed a type B-C carcinoid (Soga's classification) with positive immunoreactivity to chromogranin and cytokeratin. The presence of neurosecretory intracytoplasmic granules was demonstrated by electron microscopy. Flow cytometry showed diploid DNA content of the neoplastic cells with less than 5% of the nuclei in the S-phase region.

Bile Duct Neoplasms↗